Intravascular Data Visualization and Interface Systems and Methods

ABSTRACT

In part, the disclosure relates to intravascular data collection systems and the software-based visualization and display of intravascular data relating to detected side branches and detected stent struts. Levels of stent malapposition can be defined using a user interface such as a slider, toggle, button, field, or other interface to specify how indicia are displayed relative to detected stent struts. In addition, the disclosure relates to methods to automatically provide a two or three-dimensional visualization suitable for assessing side branch and/or guide wire location during stenting. The method can use one or more a computed side branch location, a branch takeoff angle, one or more stent strut locations, and one or more lumen contours.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority under 35 U.S.C. 119(e)from U.S. Provisional Application No. 62/196,997 filed on Jul. 25, 2015,the disclosure of which is herein incorporated by reference in itsentirety.

FIELD OF THE INVENTION

The disclosure relates generally to intravascular measurements andfeature detection and related diagnostic methods and devices.

BACKGROUND

Coronary artery disease is one of the leading causes of death worldwide.The ability to better diagnose, monitor, and treat coronary arterydiseases can be of life saving importance. Intravascular opticalcoherence tomography (OCT) is a catheter-based imaging modality thatuses light to peer into coronary artery walls and generate imagesthereof for study. Utilizing coherent light, interferometry, andmicro-optics, OCT can provide video-rate in-vivo tomography within adiseased vessel with micrometer level resolution. Viewing subsurfacestructures with high resolution using fiber-optic probes makes OCTespecially useful for minimally invasive imaging of internal tissues andorgans. This level of detail made possible with OCT allows a clinicianto diagnose as well as monitor the progression of coronary arterydisease. OCT images provide high-resolution visualization of coronaryartery morphology and can be used alone or in combination with otherinformation such as angiography data and other sources of subject datato aid in diagnosis and planning such as stent delivery planning

OCT imaging of portions of a patient's body provides a useful diagnostictool for doctors and others. For example, imaging of coronary arteriesby intravascular OCT may reveal the location of a narrowing or stenosis.This information helps cardiologists to choose between an invasivecoronary bypass surgery and a less invasive catheter-based proceduresuch as angioplasty or stent delivery. Although a popular option, stentdelivery has its own associated risks.

A stent is a tube-like structure that often is formed from a mesh. Itcan be inserted into a vessel and expanded to counteract a stenoticcondition that constricts blood flow. Stents typically are made of ametal or a polymer scaffold. They can be deployed to the site of astenosis via a catheter. During a cardiovascular procedure, a stent canbe delivered to the stenotic site through a catheter via a guide wire,and expanded using a balloon. Typically, the stent is expanded using apreset pressure to enlarge the lumen of a stenosed vessel. Angiographysystems, intravascular ultrasound systems, OCT systems, in combinationsor alone can be used to facilitate stent delivery planning and stentdeployment.

There are several factors that influence the patient outcome whendeploying stents. In some procedures, the stent should be expanded to adiameter that corresponds to the diameter of adjacent healthy vesselsegments. Stent overexpansion may cause extensive damage to the vessel,making it prone to dissection, disarticulation, and intra-muralhemorrhage. Stent under expansion may inadequately expand the vessel. Ifthe portions of the stent fail to contact the vessel wall, the risk ofthrombosis may increase. An underinflated or malapposed stent may failto restore normal flow. Once a stent is installed, stent malappositionand under expansion of the stent can result in various problems. Inaddition, flow-limiting stenoses are often present near vascular sidebranches.

Side branches can be partially or completely occluded or “jailed” bystent struts. For example, this can occur when a stent is deployed in amain vessel to address a stenosis or other malady. Side branches arevital for carrying blood to downstream tissues. Thus, jailing can havean undesired ischemic impact. The ischemic effects of jailing arecompounded when multiple side branches are impacted or when the occludedsurface area of a single branch is significant.

There are other challenges associated with stent placements and relatedprocedures. Visualizing a stent deployment relative to the wall of ablood vessel using an angiography system is challenging to undertake byinspection.

The present disclosure addresses these challenges and others.

SUMMARY

In part, the disclosure relates systems and methods for visualizingintravascular data such as detected side branches and detected stentstruts. The data can be obtained using an intravascular data collectionprobe. The probe can be pulled back through a blood vessel and data canbe collected with respect thereto. In one embodiment, the probe is anoptical probe such as an optical coherence tomography (OCT) probe. Inone embodiment, the probe is an intravascular ultrasound probe (IVUS)such as an optical coherence tomography probe. Stents can be visualizedrelative to side branches in various embodiments of the disclosure. Thisis an important feature as it is typically the case that during stentdeployment it is desirable to avoid stenting a side branch. The systemsand methods described herein facilitate visualization of stents in sidebranches using various user interface and representations of stentstruts and side branches based upon the detection of these features inthe intravascular data collected.

In part, the disclosure relates to intravascular data collection systemsand the software-based visualization and display of intravascular datarelating to detected side branches and detected stent struts. Levels ofstent malapposition can be defined using a user interface such as aslider, toggle, button, field, or other interface to specify how indiciaare displayed relative to detected stent struts. In addition, thedisclosure relates to methods to automatically provide a two orthree-dimensional visualization suitable for assessing side branchand/or guide wire location during stenting. The method can use one ormore a computed side branch location, a branch takeoff angle, one ormore stent strut locations, and one or more lumen contours.

In part, the disclosure relates systems and methods for stent planningor otherwise to generate and display diagnostic information of interest.The disclosure also relates to the generation of various indicators andthe integration of them relative to displays of image data. As anexample, a longitudinal indicator such as an apposition bar can be usedalone or in conjunction with a stent strut indicator and overlaid onangiography frames co-registered with an intravascular data set such asa set of OCT scan lines or images generated with respect thereto fordiagnostic processes such as stent planning.

In part, the disclosure relates to systems and methods for displayingthe results of data analysis applied to an intravascular data set to theuser of an intravascular data collection system and on angiographysystem in one embodiment. In part, this disclosure describes a graphicuser interface (GUI) that provides user interface and graphic datarepresentations that can be applied to one or more generated images of avessel or angiography images such that regions of interest such as areasof stent apposition and others are easy to find and understand on OCTand angiography images.

In part, the disclosure relates to a data collection system such as anintravascular data collection system suitable for use in cath lab suchas an optical coherence tomography system. In part, the disclosurerelates to a data collection system that includes a processor suitablefor displaying intravascular image data. The image data displayedincludes data or images generated based upon depth measurements. In oneembodiment, the image data is generated using optical coherencetomography. The system can also display a user interface for display ofintravascular information such as data relating to stent malappositionin a longitudinal mode on a per stent strut basis or as a bar havingregions corresponding to stent, no stent, or stent apposition levels ofpotential interest for one or more stents in a vessel. One or moreindicators such as longitudinal indicators, as a non-limiting example,can be generated in response to stent detection processing and lumenboundary detection and displayed relative to angiography, OCT, and IVUSimages. These can be viewed by a user to plan stent delivery and toinflate or adjust a stent delivery by reviewing a co-registered OCTimage and an angiography image with the relevant indicators of interest.

The present disclosure relates, in part, to computer-based visualizationof stent position within a blood vessel and one or more viewing anglesor orientations relating to one or both of a guidewire and a sidebranch. A stent can be visualized using OCT data and subsequentlydisplayed as stent struts or portions of a stent as a part of a one ormore graphic user interface(s) (GUI). A side branch and a guidewire canlikewise be detected and displayed. In one embodiment, the disclosureprovides software-based methods that can include computer algorithmsthat visualize detected intravascular features and display them in anoptimized or optimal manner suitable to enhance their diagnostic valueto an end user. The GUI can include one or more views of a blood vesselgenerated using OCT distance measurements and oriented in a positionrelative to a side branch or a guide wire to increase the diagnosticvalue or ease of use for an end user.

In part, the disclosure relates to a method of visualizing intravascularinformation obtained using an intravascular data collection probe. Themethod includes receiving intravascular data for a blood vessel, thedata comprising a plurality of image frames; storing the intravasculardata in a memory device of an intravascular data collection system;detecting one or more side branches on a per image frame basis;detecting a lumen on a per image frame basis; determining a firstviewing angle for at least one of the side branch or lumen; anddisplaying a three-dimensional visualization for at least one of theside branch or lumen. In one embodiment, the lumen is a lumen boundary.In one embodiment, a lumen contour and a lumen boundary areinterchangeable.

In one embodiment, the method further includes displaying athree-dimensional fly through relative to at least one of the sidebranch or lumen. In one embodiment, the intravascular data is opticalcoherence tomography data. In one embodiment, each image frame includesa set of scan lines. In one embodiment, the method further includesdetecting a plurality of stent struts. In one embodiment, the methodfurther includes detecting one or more guide wires.

In one embodiment, the method further includes determining a secondviewing angle for the plurality of stents struts. In one embodiment, themethod further includes determining a third viewing angle for the one ormore guidewire. In one embodiment, the three-dimensional visualizationis oriented at the first viewing angle. In one embodiment, thethree-dimensional fly through is user controllable in one or moredirections using an input device.

In one embodiment, the method further includes determining side brancharc of lumen contour; estimating side branch orientation by fitting acylinder constrained by side branch arc; and selecting orientation offitted cylinder. In one embodiment, the method further includesdetermining a mid-frame of image frames of intravascular data, determinemid-arc position on the mid frame; and set initial camera position forthree-dimensional view to orient towards intravascular imaging probe forthe mid frame.

In part, the disclosure relates to processor-based system forcontrolling stent apposition thresholds based on user inputs. The systemincludes one or more memory devices; and a computing device incommunication with the one or more memory devices, wherein the one ormore memory devices comprise instructions executable by the computingdevice to cause the computing device to: display a user interfacecomprising a stent strut apposition threshold control, the controlcomprising a user selectable input; store a user input stent strutapposition threshold in the one or more memory devices; detect one ormore stents in an intravascular data set, the intravascular data setcollected using an intravascular probe; display the one or more stentsand one or more indicia associated with the one or more stents, whereinthe indicia indicates a level of stent strut apposition, the level stentstrut apposition determined using the user selectable input. In oneembodiment, the stent strut apposition threshold control is a slider.

In one embodiment, the user selectable input is one or more values ofthe slider. In one embodiment, the indicia is one or more colors. In oneembodiment, the slider is configured to define three appositionthresholds. In one embodiment, the stent strut apposition thresholdcontrol measures stent strut apposition relative to a front face of astent strut. In one embodiment, the stent strut stent appositionthreshold control is selected from the group consisting of a formfillable field; a button; a toggle control; a dial, and a numericalselection input.

BRIEF DESCRIPTION OF DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

The figures are not necessarily to scale, emphasis instead generallybeing placed upon illustrative principles. The figures are to beconsidered illustrative in all aspects and are not intended to limit thedisclosure, the scope of which is defined only by the claims.

FIG. 1 shows a schematic diagram of an intravascular imaging and datacollection system in accordance with an illustrative embodiment of thedisclosure.

FIG. 2 is a flow chart illustrating a framework for visualization of astent in a vessel side branch according to an illustrative embodiment ofthe disclosure.

FIG. 3A is a schematic diagram illustrating virtual camera positioningfor visualizing vessel side branches according to an illustrativeembodiment of the disclosure.

FIG. 3B is a schematic diagram illustrating a virtual camera positionfor visualizing a vessel side branch according to an illustrativeembodiment of the disclosure.

FIG. 3C is a schematic diagram illustrating a virtual camera positionfor orthogonal viewing of a side branch ostium according to anillustrative embodiment of the disclosure.

FIG. 3D is a three-dimensional rendering of stent struts jailing avessel side branch ostium according to an illustrative embodiment of thedisclosure.

FIG. 4A is a side view of a three-dimensional rendering of a main vesselhaving a side branch, with a stent and multiple guidewires deployed inthe main vessel according to an illustrative embodiment of thedisclosure.

FIG. 4B is a fly-through three-dimensional rendering of a side branchlumen, with the virtual camera angle oriented along the longitudinalaxis of the side branch as shown in FIG. 3A according to an illustrativeembodiment of the disclosure.

FIG. 4C is a fly-through three-dimensional rendering of a main vessellumen, with the virtual camera angle oriented along the longitudinalaxis of the main vessel as shown in FIG. 3A according to an illustrativeembodiment of the disclosure.

FIG. 5A is a schematic diagram showing virtual camera positioning usinga mid-frame/mid-arc model according to an illustrative embodiment of thedisclosure.

FIG. 5B is a schematic diagram showing virtual camera positioning usinga cylinder model.

FIG. 6 is a schematic diagram illustrating side branch size estimationsaccording to an illustrative embodiment of the disclosure.

FIG. 7 is a schematic diagram displaying side branch location and colorcoding the degree of side branch occlusion according to an illustrativeembodiment of the disclosure.

FIG. 8 is a user display showing perspective view of a three-dimensionalrendering of a blood vessel according to an illustrative embodiment ofthe disclosure.

FIG. 9A is a side view of a three-dimensional rendering of a bloodvessel according to an illustrative embodiment of the disclosure.

FIG. 9B is a cross-sectional B-mode OCT intravascular image according toan illustrative embodiment of the disclosure.

FIG. 9C is a longitudinal L-mode OCT intravascular image according to anillustrative embodiment of the disclosure.

FIG. 10A is a side view of a three-dimensional rendering of a bloodvessel showing jailed side branches according to an illustrativeembodiment of the disclosure.

FIG. 10B is a cross-sectional B-mode OCT intravascular image accordingto an illustrative embodiment of the disclosure.

FIG. 10C is a longitudinal L-mode OCT intravascular image according toan illustrative embodiment of the disclosure.

FIG. 11A is a fly-through three-dimensional rendering of a blood vesselaccording to an illustrative embodiment of the disclosure.

FIG. 11B is a cross-sectional B-mode OCT intravascular image accordingto an illustrative embodiment of the disclosure.

FIG. 11C is a longitudinal L-mode OCT intravascular image according toan illustrative embodiment of the disclosure.

FIG. 12A is a fly-through three-dimensional rendering of a blood vesselshowing a jailed side branch according to an illustrative embodiment ofthe disclosure.

FIG. 12B is a cross-sectional B-mode OCT intravascular image accordingto an illustrative embodiment of the disclosure.

FIG. 12C is a longitudinal L-mode OCT intravascular image according toan illustrative embodiment of the disclosure.

FIG. 13A is a side view of a three-dimensional rendering of a bloodvessel showing a liberated side branch according to an illustrativeembodiment of the disclosure.

FIG. 13B is a cross-sectional B-mode OCT intravascular image accordingto an illustrative embodiment of the disclosure.

FIG. 13C is a longitudinal L-mode OCT intravascular image according toan illustrative embodiment of the disclosure.

FIG. 13D is a zoomed view of FIG. 13A, showing the ostium and a cleavedstent strut according to an illustrative embodiment of the disclosure.

FIGS. 14A, 14B, 14C, 14D show graphic user interface displays of anintravascular data collection system exemplifying a three dimensionalskin and wire frame view of a deployed stent according to anillustrative embodiment of the disclosure.

FIG. 14E shows a three dimensional fly-through display of a wire frameview of a deployed stent according to an illustrative embodiment of thedisclosure.

FIGS. 15A, 15B, 15C are user interfaces that include a user input devicesuitable for adjusting apposition thresholds that in turn control thethreshold an intravascular data collection system uses when determiningwhen to display apposition and the indicator/indicia (color, symbol,etc) to use according to an illustrative embodiment of the disclosure.

DETAILED DESCRIPTION

In part, the disclosure relates systems and methods for visualizingintravascular data such as detected side branches and detected stentstruts. The data can be obtained using an intravascular data collectionprobe. The probe can be pulled back through a blood vessel and data canbe collected with respect thereto. Such pullbacks and the associateddata collection are used to plan stent deployment or evaluate deployedstents. The resulting intravascular data from a pullback can be used invarious ways such as to visualize various blood vessel regions,features, and stents deployed in relation thereto.

Stents can be visualized relative to side branches in variousembodiments of the disclosure. This is an important feature as it istypically the case that during stent deployment it is desirable to avoidstenting a side branch. The systems and methods described hereinfacilitate visualization of stents in side branches using various userinterface and representations of stent struts and side branches basedupon the detection of these features in the intravascular datacollected.

In part, the disclosure relates to intravascular data collectionsystems, such as OCT, IVUS, and other imaging modalities and thegeneration and visualization of diagnostic information such as stentmalapposition or other indicators. The disclosure also relates tovarious user interface features that allow a user to specify parametersand thresholds of interest such as the thresholds or parameters used toevaluate when a stent is malapposed and/or the degree of apposition. Theparameters can be used to adjust or modify how and when indicators suchas graphical elements suitable for indicating diagnostic information ofinterest such as apposition levels and stent position relative toregions in the blood vessel. In one embodiment, the regions can includedetected side branches. Stent strut indicators can also be used.

Suitable diagnostic information can include stent apposition informationsuch as the relative to a vessel wall or lumen boundary and otherintravascular diagnostic information or other information generated tofacilitate stent delivery planning. The system includes a processor incommunication with the graphical user interface and configured to sendcommands to the graphical user interface. One or more software programsare used to perform one or more of the following: display indicatorssuch as color-coded stent struts or symbols or other indicia displayedat the location of detected stent struts, stent position and orientationrelative to a side branch and stent apposition levels based upon a userspecified criteria for when apposition of a stent should be displayed.

Also disclosed herein are systems and methods for visualizing stents andother medical devices relative to side branches to avoid the jailingthereof vessels. One or more software modules can be used to detect sidebranch locations, lumen contours, and stent strut positions. One or moreviewing angles or orientations can be generated to help a user visualizewhen side branch jailing may occur.

It may be necessary to open a group of cells in a deployed stent using aballoon in order to improve blood flow in the jailed side branch. Theballoon guidewire typically is crossed into the jailed side branchostium in as distal (e.g., downstream) a position as possible. Obtaininga distal guidewire position will lead to the stent struts being pushedto the proximal (e.g., upstream) side of the side branch ostium, whichminimizes flow disruptions at the higher-flow distal side of the ostium.Clear, rapid visualization of guidewire position in relation to thestent and side branch is therefore clinically advantageous.

FIG. 1 includes a system suitable for performing various steps of thedisclosure such as displaying detected stent struts, side branches, andguidewires and associated indicia and orientation angles relatingthereto. Various user interface features are described herein to viewand assess a visual representation of intravascular information. Theseuser interfaces can include one or more moveable elements that can becontrolled by a user with a mouse, joystick, or other control and can beoperated using one or more processors and memory storage elements. Forexample, the sliders of FIGS. 15A-15C can be so controlled.

During a stent delivery planning procedure, the levels and location ofapposition the user can refer to OCT and annotated angiography tofurther expand or move a stent as part of delivery planning. Thesesystem features and methods can be implemented using system 5 shown inFIG. 1.

FIG. 1 shows a system 5 which includes various data collectionsubsystems suitable for collecting data or detecting a feature of orsensing a condition of or otherwise diagnosing a subject 10. In oneembodiment, the subject is disposed upon a suitable support 12 such astable bed to chair or other suitable support. Typically, the subject 10is the human or another animal having a particular region of interest25.

The data collection system 5 includes a noninvasive imaging system suchas a nuclear magnetic resonance, x-ray, computer aided tomography, orother suitable noninvasive imaging technology. As shown as anon-limiting example of such a noninvasive imaging system, anangiography system 20 such as suitable for generating cines is shown.The angiography system 20 can include a fluoroscopy system. Angiographysystem 20 is configured to noninvasively image the subject 10 such thatframes of angiography data, typically in the form of frames of imagedata, are generated while a pullback procedure is performed using aprobe 30 such that a blood vessel in region 25 of subject 10 is imagedusing angiography in one or more imaging technologies such as OCT orIVUS, for example.

The angiography system 20 is in communication with an angiography datastorage and image management system 22, which can be implemented as aworkstation or server in one embodiment. In one embodiment, the dataprocessing relating to the collected angiography signal is performeddirectly on the detector of the angiography system 20. The images fromsystem 20 are stored and managed by the angiography data storage andimage management 22.

In one embodiment system server 50 or workstation 85 handle thefunctions of system 22. In one embodiment, the entire system 20generates electromagnetic radiation, such as x-rays. The system 20 alsoreceives such radiation after passing through the subject 10. In turn,the data processing system 22 uses the signals from the angiographysystem 20 to image one or more regions of the subject 10 includingregion 25.

As shown in this particular example, the region of interest 25 is asubset of the vascular or peripherally vascular system such as aparticular blood vessel. This can be imaged using OCT. A catheter-baseddata collection probe 30 is introduced into the subject 10 and isdisposed in the lumen of the particular blood vessel, such as forexample, a coronary artery. The probe 30 can be a variety of types ofdata collection probes such as for example an OCT probe, an FFR probe,an IVUS probe, a probe combining features of two or more of theforegoing, and other probes suitable for imaging within a blood vessel.The probe 30 typically includes a probe tip, one or more radiopaquemarkers, an optical fiber, and a torque wire. Additionally, the probetip includes one or more data collecting subsystems such as an opticalbeam director, an acoustic beam director, a pressure detector sensor,other transducers or detectors, and combinations of the foregoing.

For a probe that includes an optical beam director, the optical fiber 33is in optical communication with the probe with the beam director. Thetorque wire defines a bore in which an optical fiber is disposed. InFIG. 1, the optical fiber 33 is shown without a torque wire surroundingit. In addition, the probe 30 also includes the sheath such as a polymersheath (not shown) which forms part of a catheter. The optical fiber 33,which in the context of an OCT system is a portion of the sample arm ofan interferometer, is optically coupled to a patient interface unit(PIU) 35 as shown.

The patient interface unit 35 includes a probe connector suitable toreceive an end of the probe 30 and be optically coupled thereto.Typically, the data collection probes 30 are disposable. The PIU 35includes suitable joints and elements based on the type of datacollection probe being used. For example a combination OCT and IVUS datacollection probe requires an OCT and IVUS PIU. The PIU 35 typically alsoincludes a motor suitable for pulling back the torque wire, sheath, andoptical fiber 33 disposed therein as part of the pullback procedure. Inaddition to being pulled back, the probe tip is also typically rotatedby the PIU 35. In this way, a blood vessel of the subject 10 can beimaged longitudinally or via cross-sections. The probe 30 can also beused to measure a particular parameter such as a fractional flow reserve(FFR) or other pressure measurement.

In turn, the PIU 35 is connected to one or more intravascular datacollection systems 40. The intravascular data collection system 40 canbe an OCT system, an IVUS system, another imaging system, andcombinations of the foregoing. For example, the system 40 in the contextof probe 30 being an OCT probe can include the sample arm of aninterferometer, the reference arm of an interferometer, photodiodes, acontrol system, and patient interface unit. Similarly, as anotherexample, in the context of an IVUS system, the intravascular datacollection system 40 can include ultrasound signal generating andprocessing circuitry, noise filters, rotatable joint, motors, andinterface units. In one embodiment, the data collection system 40 andthe angiography system 20 have a shared clock or other timing signalsconfigured to synchronize angiography video frame time stamps and OCTimage frame time stamps.

In addition to the invasive and noninvasive image data collectionsystems and devices of FIG. 1, various other types of data can becollected with regard to region 25 of the subject and other parametersof interest of the subject. For example, the data collection probe 30can include one or more pressure sensors such as for example a pressurewire. A pressure wire can be used without the additions of OCT orultrasound components. Pressure readings can be obtained along thesegments of a blood vessel in region 25 of the subject 10.

Such readings can be relayed either by a wired connection or via awireless connection. As shown in a fractional flow reserve FFR datacollection system, a wireless transceiver 47 is configured to receivepressure readings from the probe 30 and transmit them to a system togenerate FFR measurements or more locations along the measured bloodvessel. One or more displays 82, 83 can also be used to show anangiography frame of data, an OCT frame, user interfaces for OCT andangiography data and other controls and features of interest.

The intravascular image data such as the frames of intravascular datagenerated using the data collection probe 30 can be routed to the datacollection processing system 40 coupled to the probe via PIU 35. Thenoninvasive image data generated using angiography system 22 can betransmitted to, stored in, and processed by one or more servers orworkstations such as the co-registration server 50 workstation 85. Avideo frame grabber device 55 such as a computer board configured tocapture the angiography image data from system 22 can be used in variousembodiments.

In one embodiment, the server 50 includes one or more co-registrationsoftware modules 67 that are stored in memory 70 and are executed byprocessor 80. The server 50 can include other typical components for aprocessor-based computing server. Alternatively, more databases such asdatabase 90 can be configured to receive image data generated,parameters of the subject, and other information generated, received byor transferred to the database 90 by one or more of the systems devicesor components shown in FIG. 1. Although database 90 is shown connectedto server 50 while being stored in memory at workstation 85, this is butone exemplary configuration. For example, the software modules 67 can berunning on a processor at workstation 85 and the database 90 can belocated in the memory of server 50. The device or system use to runvarious software modules are provided as examples. In variouscombinations the hardware and software described herein can be used toobtain frames of image data, process such image data, and register suchimage data.

As otherwise noted herein, the software modules 67 can include softwaresuch as preprocessing software, transforms, matrices, and othersoftware-based components that are used to process image data or respondto patient triggers to facilitate co-registration of different types ofimage data by other software-based components 67 or to otherwise performsuch co-registration. The modules can include lumen detection using ascan line based or image based approach, stent detection using a scanline based or image based approach, indicator generation, apposition bargeneration for stent planning, guidewire shadow indicator to preventconfusion with dissention, side branches and missing data, and others.

The database 90 can be configured to receive and store angiography imagedata 92 such as image data generated by angiography system 20 andobtained by the frame grabber 55 server 50. The database 90 can beconfigured to receive and store OCT image data 95 such as image datagenerated by OCT system 40 and obtained by the frame grabber 55 server50.

In addition, the subject 10 can be electrically coupled via one or moreelectrodes to one more monitors such as, for example, monitor 49.Monitor 49 can include without limitation an electrocardiogram monitorconfigured to generate data relating to cardiac function and showingvarious states of the subject such as systole and diastole. Knowing thecardiac phase can be used to assist the tracking of vessel centerlines,as the geometry of the heart, including the coronary arteries, isapproximately the same at a certain cardiac phase, even over differentcardiac cycles.

Hence, if the angiography data spans a few cardiac cycles, a first-ordermatching of vessel centerline at the same cardiac phase may assist intracking the centerlines throughout the pullback. In addition, as mostof the motion of the heart occurs during the systole, vessel motion isexpected to be higher around the systole, and damp towards the diastole.This provides data to one or more software modules as an indication ofthe amount of motion expected between consecutive angiography frames.Knowledge of the expected motion can be used by one or more softwaremodules to improve the tracking quality and vessel centerline quality byallowing adaptive constraints based on the expected motion.

The use of arrow heads showing directionality in a given figure or thelack thereof are not intended to limit or require a direction in whichinformation can flow. For a given connector, such as the arrows andlines shown connecting the elements shown in FIG. 1, for example,information can flow in one or more directions or in only one directionas suitable for a given embodiment. The connections can include varioussuitable data transmitting connections such as optical, wire, power,wireless, or electrical connections.

One or more software modules can be used to process frames ofangiography data received from an angiography system such as system 22shown in FIG. 1. Various software modules that can include withoutlimitation software, a component thereof, or one or more steps of asoftware-based or processor executed method can be used in a givenembodiment of the disclosure.

Intravascular Data Visualization

In one aspect, a computer-implemented method is provided to create anoptimal three-dimensional visualization for assessing an intravasculartreatment site. In various embodiments, the method includesautomatically determining an optimal camera location and viewperspective based on side branch morphology, to facilitate visualizationof the treatment site. The method can include detection of medicaldevices (e.g. stents) and related deployment devices (e.g., guidewires).This feature is particularly useful for bifurcation stenting, toidentify jailed side branches and to assist clinicians in modifyingstent cells to alleviate obstructions. The various methods describedherein relating to side branch, guide wire and other forms ofintravascular data visualization can be implemented using a softwaremodule 67 of an intravascular data collection system performing one ormore of the steps described herein.

Referring to FIG. 2, in one embodiment the computer-implemented method100 includes one or more of the following data collection steps: sidebranch detection 102, lumen contour detection 104, stent strut detection106, and guidewire detection 108. Side branch detection and lumendetection can include the sub-step of determining the optimal viewingangle 110 based on the angle at which the side branch joins the mainvessel. As described in more detail herein, these inputs are used tocreate a three-dimensional visualization of the treatment site, such asa fly-through display. Different view angles include, by way ofnon-limiting example, side view, perspective view, top view, side branchfly-through, main vessel fly-through, and orthogonal ostium views.

Referring to FIG. 3A, in one embodiment a virtual camera 150 isgenerated for one or more side branches 152 in a main vessel 154.Virtual cameras are placed at appropriate viewing angles forvisualizing, in three-dimensions, a side branch looking in the directionof the main vessel. Referring to FIG. 3B, in one mode of operation, thecamera orientation 156 is selected to be parallel to the longitudinalaxis of the side branch. Referring to FIG. 3C, in another mode, thecamera orientation 156 is selected to be orthogonal to the surface ofthe main vessel 154 and/or orthogonal to the side branch ostium 158.These view angles are exemplary, and any suitable viewing angle can beused.

Referring to FIG. 3D, in another embodiment the user can visualize thestent struts 160 that cross the side branch ostium 158. For betterviewing of the jailing stent struts, the side branch can be eliminatedfrom the display so that the user can clearly visualize the ostium andstent struts crossing the ostium. In FIG. 3D, the virtual camera isorthogonal to the side branch ostium, looking through the ostium intothe lumen of the main vessel where the stent is deployed.

FIG. 4A is a side view of a three-dimensional rendering of a main vessel154 having a side branch 152. In this embodiment, the main vesselguidewire 164, side branch guidewire 166, and stent struts 160 arevisible.

FIG. 4B is a three-dimensional rendering looking down side branch 152(e.g., a fly-through) towards main vessel 154. In this embodiment, thecamera 150 b is oriented along the direction of the side branch angle asshown in FIG. 4A. The side branch guidewire 164, main vessel guidewire166, and stent struts 160 are visible.

FIG. 4C is a three-dimensional fly-through down the main vessel 154. Inthis embodiment, the camera 150 m is oriented along the longitudinalaxis of the main branch as shown in FIG. 4A. The side branch guidewire164, main vessel guidewire 166, and stent struts 160 are visible.

In various embodiments, the method can include the step of automaticallyidentifying an initial camera position. Referring to FIG. 5A, in oneembodiment, side branch orientation is estimated by finding themid-frame 170, and the mid-arc position on the mid-frame in imaging data(e.g., OCT data). The mid-frame 170 is the center of side branch lumen172 in a given imaging frame. The mid-arc 174 is the center of the arcdefining the side branch lumen contour 176. In a preferred embodiment,the mid-arc position is used as the initial camera position 178—i.e.,where the virtual camera is placed. The initial camera orientation—i.e.,where the virtual camera is aimed—is then selected automatically. In apreferred embodiment, the camera is oriented towards the imagingcatheter 180 for that mid-frame, to provide the clinician a view downthe side branch lumen 172 towards the main vessel lumen 182. However,the camera can be oriented in any direction.

Referring to FIG. 5B, in another embodiment, camera positioning isdetermined by fitting a cylinder 184 to the side branch lumen 174. Sidebranch orientation 186 is then estimated using the arc of the cylinder184, which is a proxy for the arc of the side branch lumen contour. In apreferred embodiment, the camera 178 is positioned along the axis of theside branch 186. The initial camera orientation is then selectedautomatically. In a preferred embodiment, the camera is automaticallyoriented down the cylinder axis 186 towards the main vessel lumen 182.However, the camera can be oriented in any direction.

The disclosure also provides computer-implemented methods for enhancedvisualization of medical devices, such as guidewires and stents, on auser display. This enhanced visualization aids clinicians in evaluatinga treatment site, adjusting deployed medical devices, and assessingwhether further intervention is required. For example, it isparticularly important for the clinician to understand when a guidewireis positioned inside (i.e., luminal) of a stent or outside (i.e.,abluminal) of a stent. As another example, it is often necessary to opena group of cells in a deployed stent using a balloon in order to improveblood flow in the jailed side branch. The balloon guidewire typically iscrossed into the jailed side branch ostium in as distal (e.g.,downstream) a position as possible. Obtaining a distal guidewireposition will lead to the stent struts being pushed to the proximal(e.g., upstream) side of the side branch ostium, which minimizes flowdisruptions at the higher-flow distal side of the ostium.

Stent struts and guidewires can be detected automatically in imagingdata and can be shown on a user display to provide the clinician with acomprehensive visualization of the treatment site. Stent struts andguidewires can be displayed in a visually distinct manner, such as byusing different colors, to permit rapid interpretation by a clinician.In an embodiment, a guidewire can be shown in different colors accordingto its luminal/abluminal position relative to a stent. For example, anabluminal guidewire can be displayed in red as a warning and a luminalguidewire can be displayed in yellow. This visualization can helpclarify the point at which a guidewire crosses over into a jailedbranch, and can also help to alert the user to guidewires that have beeninadvertently positioned abluminal of a stent section in the mainbranch.

In another embodiment, where multiple guidewires are used, theguidewires may each be shown in different colors, or they guidewires maybe categorized by color. For example, a side branch guidewire may beshown in one color, and a main vessel guidewire may be shown in anothercolor. In another embodiment, a guidewire can be shown in one colorwhere it traverses the main vessel lumen and that portion of the sameguidewire, which traverses a side branch, can be shown in a differentcolor. In another embodiment, a guidewire can be shown in a differentcolor where is crosses an ostium, or where it passes through a stentcell.

Similarly, the stent and/or some of all of the stent struts can be shownin different colors to indicate potential issues such as, for example,struts that jail a side branch. For example, struts crossing an ostiumcan be shown in red whereas struts adjacent a vessel wall can be shownin blue.

In another embodiment, a side branch ostium can be demarcated by visualindicia, such as polygon highlighting around the edges of the ostium.The visual indicia can be one color for an unobstructed ostium, andanother color for an obstructed ostium.

Color-coding also can be applied to stent struts in order to clarify theposition of stent struts relative to the virtual camera. In FIGS. 4A-4C,it can be difficult to appreciate which stents are located over thebranch ostium versus which stents are located against the main vesselwall. However, referring to FIG. 3B, following automated detection ofthe individual struts and the vessel lumen, struts that are lessrelevant to visualization of wire re-crossing can be assigned ade-emphasizing color, such as grey or white, or can be removedaltogether, while more relevant struts that jail the side branch can beassigned an emphasizing color, such as red.

Colors are only one example of visual indicia that can be used inaccordance with the disclosure. For example, the indicia can be a bar,box, other any other suitable visualizable display element, symbol oricon. Preferably, the indicia demarcates the quantitatively conveys theextent of any side branch occlusion by, for example, color coding,shading, and/or varying opacity of the indicia.

Assessing Side Branch Obstruction

The invention also provides computer implemented methods for calculatingand visualizing the degree of branch obstruction. Several methods can beused to calculate branch obstruction due to the presence of pathology(e.g., stenosis) or medical intervention (e.g., jailing).

In an embodiment, a reference vessel diameter method is used to assessside branch obstruction. FIG. 6 shows a main vessel 200 having astenosis 202. A side branch 204 also is shown. A reference profile canbe created for the main vessel 206 and/or a reference profile can becreated for the side branch 208. Using the reference profile (dottedline) 208, an estimated branch diameter can be calculated by usingdistal and proximal reference profile diameters In one embodiment, thepower law is given by the expression:

D _(b) ^(ε)(i)=D ^(ε)(i+1)−D ^(ε)  (Eqn. 1)

where D(i+1) is the proximal reference profile diameter and D(i)is thedistal reference profile diameter; where D_(b)(i) is the estimated truebranch diameter; and ε is a power-law scaling exponent that has a valuebetween 2.0 and 3.0 as determined empirically.

The difference between the estimated branch diameter and the actualbranch diameter detected by OCT imaging provides the level of branchobstruction. In one embodiment, the level of branch obstruction is givenby the expression:

D _(obstruction)(i)=D _(b)(i)−D _(OCT)(i)   (Eqn. 2)

where D_(b)(i) is the estimated true branch diameter, and D_(OCT)(i) isthe actual branch diameter measured by OCT.

In an embodiment, a max diameter frames method is used to assess sidebranch obstruction. Instead of using a reference profile, the branchdiameter is estimated using the maximum diameter in the main vesselsegment distal and proximal to the current branch.

In an embodiment, a flow method is used to assess side branchobstruction. Using Virtual Flow Reserve (VFR) the flow going into eachside branch can be estimated. The difference in flow down a given sidebranch due to the difference in OCT based branch diameter Flow _(OCT)(i)and the true branch diameter Flow_(b)(i) is an additional indication ofthe effect on flow due to the obstructed side branch. The true branchdiameter can be calculated using one of the methods described above byeither using the reference vessel profile or the max diameter frame inthe distal and proximal segments. The flow method can be given as thefollowing expression:

Flow _(obstruction (i i))=Flow_(b)(i)−Flow _(OCT)(i)   (Eqn. 3)

In various embodiments, side branch flow obstruction is represented on auser display using visual indicia, such as color-coding. The indicia canbe coded to confer the level of side branch obstruction. These indiciacan also be set based upon user input via a user interface. FIG. 7 isschematic diagram of an exemplary user display. The display shows a mainvessel 200 having a stenosis 202 and three side branches 210, 212, 214.A highly obstructed side branch 212 is demarcated by different indicia(e.g., red color) than a moderately obstructed side branch 210 (e.g.,orange color) and a low/non-obstructed side branch 214 (e.g., yellowcolor).

FIG. 8 shows a user display depicting a perspective view of athree-dimensional rendering of a blood vessel 300, in accordance with anembodiment. A guidewire 302, stent struts 304, and indicia demarcatingjailed side branches 306 are visible. The user display includes a menu310 for showing/hiding guidewires, a menu 312 for selecting blood vesselfeatures to display, and a menu 314 for selecting the virtual cameraangle of the display. The user can toggle between multiple view angleson the user display. In addition, the user can toggle between differentside branches on the user display, such as by selecting particular sidebranches and/or by selecting a camera associated with a particular sidebranch.

FIGS. 9A-9C show a user display integrating a side view of athree-dimensional rendering (FIG. 9A), a corresponding B-mode OCT image(FIG. 9B), and a corresponding L-mode OCT image (FIG. 9C). FIG. 9A is aside view of a three-dimensional rendering of a blood vessel 300. Aguidewire 302 and stent struts 304 are visible. FIG. 9B shows a crosssectional B-mode OCT image. A guidewire shadow 312 and numerous stentstrut shadows 314 are clearly visible. FIG. 9C shows a longitudinalL-mode OCT image. The guidewire shadow 312 and numerous stent strutshadows are clearly visible. Vertical line 316 demarcates thecross-sectional frame shown in FIG. 9B.

FIGS. 10A-10C show a user display integrating a side view of athree-dimensional rendering (FIG. 10A), a corresponding B-mode OCT image(FIG. 1B), and a corresponding L-mode OCT image (FIG. 10C), similar toFIGS. 9A-9C. FIG. 10A includes visible indicia 306 demarcating jailedside branches.

FIGS. 11A-11C show a user display integrating a fly-through rendering(FIG. 11A), a corresponding B-mode OCT image (FIG. 11B), and acorresponding L-mode OCT image (FIG. 10C). In FIG. 11A, the guidewire302 and stent struts 304 are shown in a space-filling model. A compass320 indicates proximal and distal directions.

FIGS. 12A-12C show a similar display as shown in FIGS. 12A-12C. FIG. 12Aincludes an indicia of a jailed side branch 306, in accordance with anillustrative embodiment.

FIGS. 13A-13C show a user display integrating a side view of athree-dimensional rendering (FIG. 13A), a corresponding B-mode OCT image(FIG. 13B), and a corresponding L-mode OCT image (FIG. 13C), similar toFIGS. 9A-9C. FIG. 13A shows a side branch ostium 322 that was jailed butwas deobstructed by cutting the stent strut 324 that had jailed the sidebranch. FIG. 13D is a zoomed view of FIG. 13A, showing the ostium 322and cleaved strut 324.

Exemplary Intravascular Data Collection Embodiments

The systems and methods described herein provide diagnostic informationto support imaging needs before and after interventions related tospecific clinical applications for bifurcation, BVS, VFR for othercomplex conditions such as tandem lesions/diffuse diseases. Theembodiments include features as:

-   -   3D options for fly-through, longitudinal and branch view    -   OCT use and stent detection for BVS procedural considerations    -   Ultra-high resolution pull back for bifurcation cases    -   Independent wire selection on 3D in addition to multiple 3D        display options    -   Stent apposition mapping indicator; addition of status bar for        360 degree assessment    -   Apposition indicator ranges for Red/yellow and customization        ability to adjust ranges    -   Various user interface design elements

FIG. 14A shows an interface display exemplifying a three dimensional,skin and wire-frame view of a deployed stent based on OCT imaging data.The upper left panel shows an elevation view of a blood vessel and,specifically, the endoluminal boundary of a blood vessel is depicted inthree dimensions as a semi-transparent skin. The skin estimates orapproximates the topography of the blood vessel wall and/or the bloodvessel lumen along a region of interest. In a preferred embodiment, theskin closely approximates the contours of the lumen to enhance uservisualization of blood vessel topography, such as side branches, healthyendothelium, stenonses, lesions, and plaques. The skin can be depictedin any suitable color and preferably is semi-transparent to permitvisualization of stents deployed within the lumen.

As with other user interfaces, the double arrows allow a user to rotatethe skin view. As shown in FIG. 14A, in some embodiments, the skinitself has no thickness (i.e., is two-dimensional) and merely demarcatesthe endoluminal boundary in three dimensions. In other embodiments theskin can have nominal or substantial thickness to enhance featurevisualization. The transparency level of the lumen, skin or other layerscan be adjusted to enhance the overlay of features such as stent struts.As shown in FIG. 14B, side branch detection is enhanced using athree-dimensional interface for supporting bifurcation procedures aswell as an input to VFR calculations.

With continued reference to FIG. 14A, the upper left panel depicts adeployed stent as a wire frame graphic behind, or inside, thesemi-transparent skin. A side branch ostium is visible as a hole oropening in the skin. Stent struts are visible through thesemi-transparent skin. Stent struts can be shown in color, or by othervisual indicia, to provide further information about stent deploymentand positioning. For example, struts that are properly deployed areshown in one color (e.g., white) and struts that are malapposed (e.g.,are under-inflated, jail a side branch, etc.) are shown in a differentcolor (e.g., red). The degree or extent of stent apposition can beconveyed by color gradients, such as white for proper deployment, yellowfor potential apposition, and red for likely stent apposition. Differentcolors also can be used to distinguish between different causes ofmalapposition and the associated apposition levels or thresholds. Thesethresholds can be set using a user interface in one embodiment, such asfor example as shown in FIGS. 15A-15C. The software and controls forwhich indicia to display can be implemented using one or more softwaremodules 67.

By way of non-limiting example, stent struts that are properly expandedagainst the blood vessel wall are shown in one color (e.g., white),whereas under-inflated struts are shown in another color (e.g., purple),to alert the user that further intervention may be required to fullyexpand the stent at a particular location. Similarly, struts that jailor occlude a side branch ostium can be shown in another color (e.g.,red), and potentially jailing struts can be shown in a yet another color(e.g., yellow), to alert a user that stent adjustment or repositioningmay be required. As will be appreciated, other visual indicia can beused such as, for example, patterned lines, hatching, and shading.

The top right panel of FIG. 14A shows a cross-section of an OCT image.Stent strut cross-sections are depicted as circles. Stent struts can beshown in color, or by other visible indicia, to convey information to auser about strut positioning. For example, stent struts that areproperly expanded against the blood vessel wall are shown in one color(e.g., white), whereas struts that jail the side branch are shown inanother color (e.g., red).

The center panel of FIG. 14A shows a longitudinal or L-mode rendering ofthe OCT data. The cross-section frame corresponds to the vertical linewithin the region of interest. The bottom panel of FIG. 14A shows an OCTL-mode image of a blood vessel co-registered with a wire-framerepresentation of a deployed stent. Again, stent struts that areproperly expanded against the blood vessel wall are shown in one color(e.g., white), whereas struts that jail the side branch are shown inanother color (e.g., red).

FIG. 14C shows an interface display exemplifying a three dimensional,skin and wire-frame view of a deployed stent based on OCT imaging data.The user display can include the option to display or hide one or morefeatures, such as the skin, guidewire, and/or stent struts. In additionthe color and transparency of the skin can be altered, to make the skinmore transparent or more opaque.

FIG. 14D shows a fly-though display exemplifying a three dimensional,skin and wire-frame view of a deployed stent. Distal (D), or downstreamdirection and proximal (P), or upstream directions are shown. Theinterface display also can include a positional marker indicating thelocation of the cross-sectional images within the region of interest.The interface display can further include a luminal marker thathighlights the lumen boundary/contour to make vessel's topography moreapparent.

FIG. 14E shows a fly-though display exemplifying a three dimensionalwire-frame view of a deployed stent. In this embodiment, the skin is notshown, leaving only the stent struts and guidewire. In some situations,stent apposition may be clearer when the skin is not shown. The skin canbe toggled on and off as part of the three-dimensional view andthree-dimensional fly through relative to the lumen along the length ofblood vessel.

User Interface Features for Apposition Levels

The process of establishing stent apposition values such as anapposition threshold can vary from one end user of an intravasculardiagnostic system to another. An end user can adjust the appositionthresholds for the stents using an interface as shown in FIGS. 15A, 15B,and 15C. In FIG. 15A, the user interface for adjusting stent appositionvalues is shown relative to a graphic user interface for an OCT system.This interface can be used for IVUS and other imaging modalities. Thestent strut shown by the dotted back has an arrow that can extend to oneor more surfaces or within the stent strut as a changed able feature.This allows apposition to be specified relative to a location on orwithin the strut as of interest to the user. In FIGS. 15A and 15B, thethree levels or thresholds for scoring or identify apposition levels arebetween 0 and 200 microns, 200 and 300 microns, and from 300 microns to600. As shown in FIG. 15B, the three colored bars shown allow threeapposition thresholds to be set. These thresholds control how and whenstent apposition is displayed. The strut apposition distance is shown bythe double-headed arrow in the figure relative to the stent strut andthe lumen contour.

The lumen contour is the detected or calculated boundary of the lumen ofthe blood vessel. Preferably, the stent strut would be close to thelumen contour. To the extent the strut apposition indicates that thefront face of the strut is a known distance from the lumen contour, theend user can use their knowledge of stent thicknesses to set anapposition threshold that meets their individual needs. The appositionthreshold can be set as in FIG. 15C such that only two levelsappear—apposed or not apposed. Two, three or more such levels can beset. In one embodiment, as shown in FIGS. 15A and 15B the slider bar hasbeen adjusted to set the apposition (malapposition) thresholds such thatthree indicators are used to modify the graphics of the stent strutsdisplayed. The term apposition can include malapposition as it is usedto describe a degree of a stent deviating from its preferred level ofexpansion or placement relative to a vessel wall.

Levels of stent malapposition, such as by an apposition threshold forevaluating detected stent struts relative to a detected lumen contour,can be defined using a user interface. The interface can be a slider(shown in FIGS. 15A-15C) or other user interfaces such as a togglecontrol, one or more buttons, a field for percentage or distance orentry of another apposition parameter, or other interfaces to specifyhow indicia are displayed relative to detected stent struts and thestent strut apposition level. Any suitable interface for selecting orinputting an apposition threshold can be used. In one embodiment, theapposition does not specify stent strut thickness but rather uses thestent strut end face. In this way, the end user can adjust the thresholdbased on their expertise and the thickness of the stent struts in use.

Non-Limiting Software Features and Embodiments for ImplementingInterface, Detection and Other Features of Disclosure

The following description is intended to provide an overview of devicehardware and other operating components suitable for performing themethods of the disclosure described herein. This description is notintended to limit the applicable environments or the scope of thedisclosure. Similarly, the hardware and other operating components maybe suitable as part of the apparatuses described above. The disclosurecan be practiced with other system configurations, including personalcomputers, multiprocessor systems, microprocessor-based or programmableelectronic device, network PCs, minicomputers, mainframe computers, andthe like. The disclosure can also be practiced in distributed computingenvironments where tasks are performed by remote processing devices thatare linked through a communications network such as in different roomsof a catheter or cath lab.

Some portions of the detailed description are presented in terms ofmethods such as algorithms and symbolic representations of operations ondata bits within a computer memory.

These algorithmic descriptions and representations can be used by thoseskilled in the computer and software related fields. In one embodiment,an algorithm is here, and generally, conceived to be a self-consistentsequence of operations leading to a desired result. The operationsperformed as methods stops or otherwise described herein are thoserequiring physical manipulations of physical quantities. Usually, thoughnot necessarily, these quantities take the form of electrical ormagnetic signals capable of being stored, transferred, combined,transformed, compared, and otherwise manipulated.

Unless specifically stated otherwise as apparent from the followingdiscussion, it is appreciated that throughout the description,discussions utilizing terms such as “processing” or “computing” or“searching” or “indicating” or “detecting” or “measuring” or“calculating” or “comparing” or “generating” or “sensing” or“determining” or “displaying,” or Boolean logic or other set relatedoperations or the like, refer to the action and processes of a computersystem, or electronic device, that manipulates and transforms datarepresented as physical (electronic) quantities within the computersystem's or electronic devices' registers and memories into other datasimilarly represented as physical quantities within electronic memoriesor registers or other such information storage, transmission or displaydevices.

The present disclosure, in some embodiments, also relates to apparatusfor performing the operations herein. This apparatus may be speciallyconstructed for the required purposes, or it may comprise a generalpurpose computer selectively activated or reconfigured by a computerprogram stored in the computer. Various circuits and components thereofcan be used to perform some of the data collection and transformationand processing described herein.

The algorithms and displays presented herein are not inherently relatedto any particular computer or other apparatus. Various general purposesystems may be used with programs in accordance with the teachingsherein, or it may prove convenient to construct more specializedapparatus to perform the required method steps. The required structurefor a variety of these systems will appear from the description providedherein. In addition, the present disclosure is not described withreference to any particular programming language, and variousembodiments may thus be implemented using a variety of programminglanguages. In one embodiment, the software instructions are configuredfor operation on a microprocessor or ASIC of an intravascularimaging/data collection system.

Embodiments of the disclosure may be implemented in many differentforms, including, but in no way limited to, computer program logic foruse with a processor (e.g., a microprocessor, microcontroller, digitalsignal processor, or general purpose computer), programmable logic foruse with a programmable logic device, (e.g., a Field Programmable GateArray (FPGA) or other PLD), discrete components, integrated circuitry(e.g., an Application Specific Integrated Circuit (ASIC)), or any othermeans including any combination thereof.

In a typical embodiment of the present disclosure, some or all of theprocessing of the data collected using an OCT probe, an IVUS probe,other imaging probes, an angiography system, and other imaging andsubject monitoring devices and the processor-based system is implementedas a set of computer program instructions that is converted into acomputer executable form, stored as such in a computer readable medium,and executed by a microprocessor under the control of an operatingsystem. Thus, user interface instructions and triggers based upon thecompletion of a pullback or a co-registration request, for example, aretransformed into processor understandable instructions suitable forgenerating OCT data, performing image procession using various and otherfeatures and embodiments described above.

In addition, user interface commands, a user query, a system response,transmitted probe data, input data and other data and signal describedherein are transformed into processor understandable instructionssuitable for responding to user interface selections, controlling agraphical user interface, control and graphic signal processing,displaying cross-sectional information, rendered stents and guidewiresand images from other data collection modalities, generating anddisplaying stents and indicators and other intravascular data,displaying OCT, angiography, detecting shadows, detecting peaks, andother data as part of a graphic user interface and other features andembodiments as described above. Data and parameters suitable for displayas GUI components or controls, values, or as another representation in agraphical user interface can include without limitation guidewire,apposition bars, user interface panels, masks, stent struts, missingdata representations, shadows, angiography representations, three andtwo dimensional renders and views, and other features as describedherein.

Computer program logic implementing all or part of the functionalitypreviously described herein may be embodied in various forms, including,but in no way limited to, a source code form, a computer executableform, and various intermediate forms (e.g., forms generated by anassembler, compiler, linker, or locator). Source code may include aseries of computer program instructions implemented in any of variousprogramming languages (e.g., an object code, an assembly language, or ahigh-level language such as Fortran, C, C++, JAVA, or HTML) for use withvarious operating systems or operating environments. The source code maydefine and use various data structures and communication messages. Thesource code may be in a computer executable form (e.g., via aninterpreter), or the source code may be converted (e.g., via atranslator, assembler, or compiler) into a computer executable form.

The computer program may be fixed in any form (e.g., source code form,computer executable form, or an intermediate form) either permanently ortransitorily in a tangible storage medium, such as a semiconductormemory device (e.g., a RAM, ROM, PROM, EEPROM, or Flash-ProgrammableRAM), a magnetic memory device (e.g., a diskette or fixed disk), anoptical memory device (e.g., a CD-ROM), a PC card (e.g., PCMCIA card),or other memory device. The computer program may be fixed in any form ina signal that is transmittable to a computer using any of variouscommunication technologies, including, but in no way limited to, analogtechnologies, digital technologies, optical technologies, wirelesstechnologies (e.g., Bluetooth), networking technologies, andinternetworking technologies. The computer program may be distributed inany form as a removable storage medium with accompanying printed orelectronic documentation (e.g., shrink-wrapped software), preloaded witha computer system (e.g., on system ROM or fixed disk), or distributedfrom a server or electronic bulletin board over the communication system(e.g., the internet or World Wide Web).

Hardware logic (including programmable logic for use with a programmablelogic device) implementing all or part of the functionality previouslydescribed herein may be designed using traditional manual methods, ormay be designed, captured, simulated, or documented electronically usingvarious tools, such as Computer Aided Design (CAD), a hardwaredescription language (e.g., VHDL or AHDL), or a PLD programming language(e.g., PALASM, ABEL, or CUPL).

Programmable logic may be fixed either permanently or transitorily in atangible storage medium, such as a semiconductor memory device (e.g., aRAM, ROM, PROM, EEPROM, or Flash-Programmable RAM), a magnetic memorydevice (e.g., a diskette or fixed disk), an optical memory device (e.g.,a CD-ROM), or other memory device. The programmable logic may be fixedin a signal that is transmittable to a computer using any of variouscommunication technologies, including, but in no way limited to, analogtechnologies, digital technologies, optical technologies, wirelesstechnologies (e.g., Bluetooth), networking technologies, andinternetworking technologies. The programmable logic may be distributedas a removable storage medium with accompanying printed or electronicdocumentation (e.g., shrink-wrapped software), preloaded with a computersystem (e.g., on system ROM or fixed disk), or distributed from a serveror electronic bulletin board over the communication system (e.g., theinternet or World Wide Web).

Various examples of suitable processing modules are discussed below inmore detail. As used herein a module refers to software, hardware, orfirmware suitable for performing a specific data processing or datatransmission task. In one embodiment, a module refers to a softwareroutine, program, or other memory resident application suitable forreceiving, transforming, routing and processing instructions, or varioustypes of data such as angiography data, OCT data, IVUS data, offsets,shadows, pixels, intensity patterns, guidewire segments, sidebranchorientation, stent orientation, stent position relative to side branchposition, user interface data, control signals, angiography data, useractions, frequencies, interferometer signal data, detected stents,candidate stent struts, IVUS data, shadows, pixels, intensity patterns,scores, projections, and guidewire data and other information ofinterest as described herein.

Computers and computer systems described herein may include operativelyassociated computer-readable media such as memory for storing softwareapplications used in obtaining, processing, storing and/or communicatingdata. It can be appreciated that such memory can be internal, external,remote or local with respect to its operatively associated computer orcomputer system.

Memory may also include any means for storing software or otherinstructions including, for example and without limitation, a hard disk,an optical disk, floppy disk, DVD (digital versatile disc), CD (compactdisc), memory stick, flash memory, ROM (read only memory), RAM (randomaccess memory), DRAM (dynamic random access memory), PROM (programmableROM), EEPROM (extended erasable PROM), and/or other likecomputer-readable media.

In general, computer-readable memory media applied in association withembodiments of the disclosure described herein may include any memorymedium capable of storing instructions executed by a programmableapparatus. Where applicable, method steps described herein may beembodied or executed as instructions stored on a computer-readablememory medium or memory media. These instructions may be softwareembodied in various programming languages such as C++, C, Java, and/or avariety of other kinds of software programming languages that may beapplied to create instructions in accordance with embodiments of thedisclosure.

The term “machine-readable medium” or “computer-readable-medium”includes any medium that is capable of storing, encoding or carrying aset of instructions for execution by the machine and that cause themachine to perform any one or more of the methodologies of the presentdisclosure. While the machine-readable medium is shown in an exampleembodiment to be a single medium, the term “machine-readable medium”should be taken to include a single medium or multiple media (e.g., adatabase, one or more centralized or distributed databases and/orassociated caches and servers) that store the one or more sets ofinstructions.

A storage medium may be non-transitory or include a non-transitorydevice. Accordingly, a non-transitory storage medium or non-transitorydevice may include a device that is tangible, meaning that the devicehas a concrete physical form, although the device may change itsphysical state. Thus, for example, non-transitory refers to a deviceremaining tangible despite this change in state.

The aspects, embodiments, features, and examples of the disclosure areto be considered illustrative in all respects and are not intended tolimit the disclosure, the scope of which is defined only by the claims.Other embodiments, modifications, and usages will be apparent to thoseskilled in the art without departing from the spirit and scope of theclaimed invention.

The use of headings and sections in the application is not meant tolimit the invention; each section can apply to any aspect, embodiment,or feature of the invention.

Throughout the application, where compositions are described as having,including, or comprising specific components, or where processes aredescribed as having, including or comprising specific process steps, itis contemplated that compositions of the present teachings also consistessentially of, or consist of, the recited components, and that theprocesses of the present teachings also consist essentially of, orconsist of, the recited process steps.

In the application, where an element or component is said to be includedin and/or selected from a list of recited elements or components, itshould be understood that the element or component can be any one of therecited elements or components and can be selected from a groupconsisting of two or more of the recited elements or components.Further, it should be understood that elements and/or features of acomposition, an apparatus, or a method described herein can be combinedin a variety of ways without departing from the spirit and scope of thepresent teachings, whether explicit or implicit herein.

The use of the terms “include,” “includes,” “including,” “have,” “has,”or “having” should be generally understood as open-ended andnon-limiting unless specifically stated otherwise.

The use of the singular herein includes the plural (and vice versa)unless specifically stated otherwise. Moreover, the singular forms “a,”“an,” and “the” include plural forms unless the context clearly dictatesotherwise. In addition, where the use of the term “about” is before aquantitative value, the present teachings also include the specificquantitative value itself, unless specifically stated otherwise. As usedherein, the term “about” refers to a ±10% variation from the nominalvalue.

It should be understood that the order of steps or order for performingcertain actions is immaterial so long as the present teachings remainoperable. Moreover, two or more steps or actions may be conductedsimultaneously. The examples presented herein are intended to illustratepotential and specific implementations of the disclosure. It can beappreciated that the examples are intended primarily for purposes ofillustration of the disclosure for those skilled in the art. There maybe variations to these diagrams or the operations described hereinwithout departing from the spirit of the disclosure. For instance, incertain cases, method steps or operations may be performed or executedin differing order, or operations may be added, deleted or modified.

Where a range or list of values is provided, each intervening valuebetween the upper and lower limits of that range or list of values isindividually contemplated and is encompassed within the invention as ifeach value were specifically enumerated herein. In addition, smallerranges between and including the upper and lower limits of a given rangeare contemplated and encompassed within the invention. The listing ofexemplary values or ranges is not a disclaimer of other values or rangesbetween and including the upper and lower limits of a given range.

Furthermore, whereas particular embodiments of the disclosure have beendescribed herein for the purpose of illustrating the disclosure and notfor the purpose of limiting the same, it will be appreciated by those ofordinary skill in the art that numerous variations of the details,materials and arrangement of elements, steps, structures, and/or partsmay be made within the principle and scope of the disclosure withoutdeparting from the disclosure as described in the claims.

Furthermore, whereas particular embodiments of the disclosure have beendescribed herein for the purpose of illustrating the disclosure and notfor the purpose of limiting the same, it will be appreciated by those ofordinary skill in the art that numerous variations of the details,materials and arrangement of elements, steps, structures, and/or partsmay be made within the principle and scope of the disclosure withoutdeparting from the disclosure as described in the claims.

What is claimed is:
 1. A method of visualizing intravascular informationobtained using an intravascular data collection probe, the methodcomprising the steps of: receiving intravascular data for a bloodvessel, the data comprising a plurality of image frames; storing theintravascular data in a memory device of an intravascular datacollection system; detecting one or more side branches on a per imageframe basis; detecting a lumen on a per image frame basis; determining afirst viewing angle for at least one of the side branch or lumen; anddisplaying a three-dimensional visualization for at least one of theside branch or lumen.
 2. The method of claim 1 wherein the lumen is alumen boundary.
 3. The method of claim 1 further comprising displaying athree-dimensional fly through relative to at least one of the sidebranch or lumen.
 4. The method of claim 1 wherein the intravascular datais optical coherence tomography data.
 5. The method of claim 4 whereineach image frame comprises a set of scan lines.
 6. The method of claim 1further comprising detecting a plurality of stent struts.
 7. The methodof claim 1 further comprising detecting one or more guide wires.
 8. Themethod of claim 6 further comprising determining a second viewing anglefor the plurality of stents struts.
 9. The method of claim 7 furthercomprising determining a third viewing angle for the one or moreguidewires.
 10. The method of claim 1 wherein the three-dimensionalvisualization is oriented at the first viewing angle.
 11. The method ofclaim 3 wherein the three-dimensional fly through is user controllablein one or more directions using an input device.
 12. The method of claim1 further comprising determining a side branch arc of lumen contour;estimating side branch orientation by fitting a cylinder constrained byside branch arc; and selecting orientation of fitted cylinder.
 13. Themethod of claim 1 further comprising determining a mid-frame of imageframes of intravascular data, determine mid-arc position on the midframe; and set initial camera position for three-dimensional view toorient towards intravascular imaging probe for the mid-frame.
 14. Aprocessor-based system for controlling stent apposition thresholds basedon user inputs, the system comprising: one or more memory devices; and acomputing device in communication with the one or more memory devices,wherein the one or more memory devices comprise instructions executableby the computing device to cause the computing device to: display a userinterface comprising a stent strut apposition threshold control, thecontrol comprising a user selectable input; store a user input stentstrut apposition threshold in the one or more memory devices; detect oneor more stents in an intravascular data set, the intravascular data setcollected using an intravascular probe; display the one or more stentsand one or more indicia associated with the one or more stents, whereinthe indicia indicates a level of stent strut apposition, the level stentstrut apposition determined using the user selectable input.
 15. Themethod of claim 14 wherein the stent strut apposition threshold controlis a slider.
 16. The method of claim 15 wherein the user selectableinput is one or more values of the slider.
 17. The method of claim 14wherein the indicia is one or more colors.
 18. The method of claim 15wherein the slider is configured to define three apposition thresholds.19. The method of claim 1 wherein the stent strut apposition thresholdcontrol measures stent strut apposition relative to a front face of astent strut.
 20. The method of claim 1 wherein the stent strut stentapposition threshold control is selected from the group consisting of aform fillable field; a button; a toggle control; a dial, and a numericalselection input.